Managed Care - April 2008 - (Page 26) trol cost, according to a survey of nine health plans Aetna’s Un, and he has data to prove it. conducted by AHIP last year. In 2003, the company developed what it calls These proven techniques have resulted in major the Medical/Psychiatric High Risk Case Manageprogress in access to care over the last 25 years, acment Program (Med Psych). Its purpose is to mancording to David Mechanic, PhD, director of the Inage the treatment of members experiencing destitute for Health, Health Care Policy, and Aging at pression or other mental health issues who also Rutgers University. “Looking back, major have chronic conditions such as cancer, diprogress is evident. We have improved medabetes, or congestive heart failure. The proical and rehabilitative care, although psygram integrates and coordinates medical chosocial evidence-based services are not and behavioral health services. Med Psych widely accessible. More people now receive case managers help members arrange for mental health services, and we have a much treatment, provide educational materials, clearer view of evidence-based care,” said and help monitor adherence to treatment. Mechanic in a report in the November/DeLast year Aetna announced the results of cember 2007 issue of Health Affairs titled an evaluation of claims data for members “Mental Health Services Then and Now.” enrolled in the program. The evaluation “It makes good He added, however, that “much remains to medical sense to looked at medical, pharmacy, and utilization be done.” costs over one year and compared members treat mental illness Parity is a step in the right direction, ac- like any other chron- who were enrolled in the Med Psych procording to Richard Frank, PhD, of Harvard ic disease,” says gram with those who were not enrolled. Medical School, who has studied the role of Donna Zimmerman, Claims data for 2,737 Aetna HMO members vice president for managed care in the provision of mental government affairs and 1,834 Aetna PPO members were evaluhealth services. In a review of mental health at HealthPartners in ated. policy and practice over the last 25 years Minneapolis. A post evaluation of enrolled patients (also published in the November/December showed an increase in self-perception of 2007 issue of Health Affairs in an article titled “Menphysical and mental health as measured by SF12 tal Health in the Mainstream of Health Care”), scores. (The SF12 is an industry standard, 12-item, Frank concluded that: self-administered questionnaire that assesses symptoms, functioning, and quality of life.) Enrollees reported they had been at work three days more per Efficiency of mental health insurance coverage bemonth after enrolling in the program. came an especially strong concern during the late Aetna Behavioral Health demonstrated a total 1980s as the specialty inpatient psychiatric industry cost savings of $136 per member per month grew and, for the first time, spending growth in men(PMPM) when members were enrolled in the protal health rivaled overall health care spending growth. gram compared to members who were not enThis fueled the development of the managed behavrolled. Results also showed that medical costs deioral health care (MBHC) industry and the research creased by $175 PMPM, although overall pharmacy program studying its effects. This research suggested costs rose $39 PMPM. that utilization could be managed, costs controlled, “While we saw an increase in pharmacy costs, and quality maintained. The rise of MBHC, in turn, made parity in private health insurance coverage afthis was offset by an overall decrease in medical fordable. States and the Federal Employees Health costs,” said Un, in a statement about the programs’ Benefits (FEHB) program responded by establishing results. “We believe these results are evidence that parity coverage for mental health in the context of the program had a positive impact on adherence to mainstream care. Congress appears to be slouching medication for both behavioral health and cotoward parity legislation. morbid chronic medical conditions. The results are encouraging because we now have hard evidence that integrating the case management of beThe tools used to manage behavioral health benhavioral health care and pharmacy with medical efits (which refers to both mental health and subcan have a positive impact on members’ overall stance abuse benefits) can indeed be very effective health and help to manage the costs associated with in controlling costs and improving quality, says 26 MANAGED CARE / APRIL 2008
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